Hypertension in patients on dialysis: diagnosis, mechanisms, and management.

Autor: Bucharles SGE; Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil.; Fundação Pró Renal, Curitiba, PR, Brasil., Wallbach KKS; Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil., Moraes TP; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil., Pecoits-Filho R; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil.
Jazyk: English; Portuguese
Zdroj: Jornal brasileiro de nefrologia [J Bras Nefrol] 2019 Jul-Sep; Vol. 41 (3), pp. 400-411. Date of Electronic Publication: 2018 Nov 08.
DOI: 10.1590/2175-8239-JBN-2018-0155
Abstrakt: Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.
Databáze: MEDLINE